An Overview of Postnasal Drip

Postnasal drip, which is also called upper airway cough syndrome, is when mucus from a runny nose drains down the back of your throat. Conditions such as allergies and infections can trigger excessive mucus production, which can lead to this. It is normal to have a layer of mucus in the back of your throat, as it helps protect you from illness and provides lubrication. But when you feel like you are swallowing or coughing up a large amount, be it thin or thick, it often becomes bothersome.

Postnasal drip is typically diagnosed based on your complaints, and there are a number of effective home remedies and medications that can help clear it up.

Postnasal drip generally lasts for a few days or weeks, depending on the cause. Sometimes, it can be chronic; you may experience it for months on end. The effects are generally mild and you can have a combination of symptoms.

Symptoms of postnasal drip include:

• Feeling like you need to clear your throat
• A sore throat
• Occasional coughing
• Scratchy, tickling, or itching in the back of your throat
• Burning feeling of your throat
• The sensation of a lump in the back of your throat
• Hoarse voice
• Losing your voice
• Persistent cough

These symptoms can fluctuate throughout the day, and you may feel worse after lying down for a while or after speaking for a long time.

Post-nasal drip does not always require a consultation with a medical professional, and it often goes away on its own.

However, you should see a doctor if:

• Your symptoms last longer than a few weeks
• You have difficulty swallowing
• You feel like you're choking
• You have trouble breathing
• You have a fever, vomiting, or ear pain, which are signs of an infection that requires medical treatment

There are a number of different causes of postnasal drip. In some instances, your body produces more mucus, and in others, your body might not clear the mucus as quickly as usual, which makes it build up.

Common causes of postnasal drip include:

• Allergies to pollen, mold, dust, or dander
• Swallowing problems
• Acid reflux, gastroesophageal reflux disease (GERD) 
• Anatomical abnormalities such as a deviated septum or enlarged turbinates
• Certain medications, including contraceptives and antihypertensives to control blood pressure
• Rebound congestion due to overuse of pseudoephedrine nasal sprays

• Infections: For example, sinusitis, the common cold, influenza, cytomegalovirusvirus (CMV), respiratory syncytial virus (RSV), and adenovirus
• Seasonal allergies
• Pregnancy-induced rhinitis 
• Hormone fluctuations
• Strep throat 

• Eating spicy foods
• Eating dairy products
• Foreign objects stuck in the nose
• Exercise-induced rhinitis
• Pet allergies

Postnasal drip is generally diagnosed based on your symptoms. When you cough, you might notice thick or thin phlegm, and this is typically a sign that postnasal drip is part of your condition. Typically, your other symptoms besides postnasal drip can help in determining the cause.

If you have a fever, your postnasal drip may be caused by an infection. Your doctor will look in the back of your throat to see if there is any redness or swelling, and he will also look for and ask about other signs of infection (such as headaches, fever, chills, and muscle aches).

If your phlegm is blood-tinged, this could be a sign of a gastrointestinal or pulmonary infection or a medical condition that requires further evaluation.

If your postnasal drip symptoms recur every few days or weeks and resolve in between episodes, then it could be related to an allergic reaction or sensitivity, such as to food. Your medical team may encourage you to keep a diary of your symptoms, noting what you ate and what you may have been exposed to (such as pollen or pets). Allergy testing may help pinpoint the trigger.

If you have postnasal drip frequently, or all the time, you could have an anatomical cause, such as a deviated septum. You will need to have a physical examination and imaging tests so that your medical team can visualize any variations that could be causing your symptoms.

Postnasal drip diagnosis may involve interventional tests if GERD is believed to be the possible cause. GERD diagnosis may include tests such as direct laryngoscopy (which visualizes the upper throat), 24-hour pH probe (which can test for acid reflux), or esophagogastroduodenoscopy (which visualizes the lining of your esophagus, stomach, and small intestine).

There are a number of strategies for treating postnasal drip. Some tips can make you more comfortable, regardless of the cause:

• Drink a lot of water to lubricate your throat and keep your mucus thin (thin mucus is less bothersome).
• Use a cool mist humidifier at night while you sleep.
• Use a vaporizer, diffuser, or neti pot, which can be infused with essential oils, such as peppermint or eucalyptus.

Congestion, sore throat, and cough can often be managed with over-the-counter (OTC) therapies:

• Acetaminophen or cough lozenges can ease a sore throat.
• Saline nasal spray can decrease congestion.
• Medicated nasal spray, such as Afrin (oxymetazoline), can help you breathe more comfortably.
• Vapor rubs may help reduce congestion.
• Mucinex (guaifenesin) can decrease congestion.
• Claritin (loratadine) or Sudafed (pseudoephedrine), Benadryl (diphenhydramine) are antihistamines that may help to relieve congestion.

There are also a number of prescription medications used for the treatment of postnasal drip. For example, treatments for hay fever include some OTC and some prescription medications. For persistent postnasal drip, or for postnasal drip complicated by asthma, Atrovent (ipratropium bromide) or steroids may be prescribed.

If you have a bacterial or fungal respiratory infection, you need antibiotics.

GERD requires treatment with a multi-pronged approach, which includes avoiding fatty and spicy foods, OTC or prescription medications, and sleeping with your head slightly elevated, rather than flat.

Anatomical variations may require a surgical repair, such as sinus surgery, submucosal resection of the nose, or turbinate reduction

Postnasal drip is very common. If you experience it a few times per year, then there is probably nothing to worry about. But if you seem to have postnasal drip frequently or on a regular basis, you should talk to your doctor about it. You might have an underlying cause that can be treated.